Healthcare Provider Details

I. General information

NPI: 1538469267
Provider Name (Legal Business Name): WESTERN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 E POST RD
LAS VEGAS NV
89120-3992
US

IV. Provider business mailing address

1626 S EDWARD DR
TEMPE AZ
85281-6200
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-5500
  • Fax: 702-262-9997
Mailing address:
  • Phone: 602-252-5000
  • Fax: 602-323-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number200035-424
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number2000035-424
License Number StateNV

VIII. Authorized Official

Name: MR. ROBERT A COSTON
Title or Position: MANAGER
Credential: BILLING MANAGER
Phone: 480-246-3950